Embedding 48/6 into Practice

Gail Brown, Director of Acute Initiatives & Project LeadJames Chan, Manager Quality, Patient Safety and Accreditation Maureen Detwiller, Regional Practice Leader Kathy Williams, Regional Professional Practice Lead Allied Health

48/6 Provincial CCM

Seniors Hospital Care WG & BC Safety Quality Council:

Within 48 hours of decision to admit to hospital, assess

patients in 6 functional areas and initiate a plan of care

(regardless of location)

Primary goal is to prevent or minimize functional decline while attending to an acute medical episode in hospital

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48/6

Cognition

Mobility

Pain

Medication

Bowel Bladder

Nutrition Hydration

Psychosocial Abilities

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Not More Change!!!MoreOB

Hot Stroke

Surgical pathways

ACP - MOSTVulnerable Adult

Ebola

PEWS

ABCDE Bundles New IV pumps

Accreditation

COPD standards

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Site Visit Observations

Patient’s Perspective:• Repetitive questions about health history • Mixed messages from staff; “not sure” what’s

next• Passively waiting for health professionals to

“tell” them what they need to do next

Staff Perspective:• Hunting and gathering info takes time away from pt

care• Frustration with communication systems – duplicate

documentation; • Reliance on Patient Care Coordinators for “the plan”• No standardized documentation system across Interior

Health• Every health care provider “starts fresh”• Allied Health professionals are consultants

Site Visit Observations

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Eureka!!! The Plan…..

48/6 Stan Dard Documentation

Huddles

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Guiding Principles

1. Integrate and embed 48/6 practices – NOT add work to current practices

2. Streamline and standardize documentation 3. Facilitate interprofessional collaboration

across portfolios and disciplines 4. Build systems and processes that are

sustainable and easily measured

So our Evaluation Question is…. To what extent does the application of 48/6 tools and

processes (care planning, huddles) improve perceived shared decision making?

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Subquestions:

- What is the current level of interprofessional collaborative practice?

- Does the level of interprofessional practice improve with 48/6?

Survey Results Summary

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Total Survey Responses n=397Complete Responses

n=259

Incomplete Responsesn=129

Blank Responsesn=27

Demographic Only (eg. Q2/Q3) n=70

Demographic + Other Responsesn=32

Terminated Responses n=9

*291 Responses were used for the analysis (i.e. blue boxes)

Key Findings• There are no statistically significant

differences between inter-professional collaboration (IPC) scores at different sized hospitals

– Small (<20 beds)– Medium (20-120 beds)– Large (>120 beds)

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Key Findings• Overall, there is no significant difference

between IPC scores of nurses and allied health professionals

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Key Findings

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Not at all Once per week 2-3 times per week 4-5 times per week 6-7 times per week3.30

3.40

3.50

3.60

3.70

3.80

3.90

4.00

4.10

3.59

3.72

3.84

3.90

3.97

IPC

Scor

e

• The more frequent the inter-professional huddle, the higher the IPC score

Key Findings

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Not at all For few patients (10-30%) For some patients (30-60%)

For many patients (60-90%)

For all patients3.40

3.50

3.60

3.70

3.80

3.90

4.00

4.10

4.20

3.63

3.70 3.70

3.88

4.08

IPC

Scor

e

• The more frequent a Plan of Care is used, the higher the IPC score

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Lessons Learned

• Use multiple approaches – no one model fits• Focus on what staff value in their practice• Find synergies with other initiatives & changes• Build as you go…..leaders do not have all the

answers…….the front line do!• Listen to, and act on feedback

Questions

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